The NMC (2004, 2010) has published standards for education programmes (Diplomas/Degrees in Nursing) and requires all student nurses to meet these standards and competencies during their education and before registering. This is one reason why you are studying the social context of care. If you read the standards you will understand why a wider knowledge of the context of care is required for nurses at the point of registration.
Some students continue to struggle to see the relevance of sociology to their experience of nursing in clinical practice. The debate over sociology has been reflected in the literature especially in the late 1990’s but is still current. Does sociology have any relevance to nursing?’ The answer is partly based on what one thinks nursing practiceis.
The case for sociology in nursing (Mulholland 1997):
1) It provides an alternative to individualistic biomedical models.
2) Supports critical and self reflective practice.
3) Addresses exercise of power.
4) Encourages a ‘quality of mind’ (Mills 1959).
5) Challenges the ‘taken for granted’.
6) Involves the ‘know why’ not just the ‘know how’.
One view is that nursing uses a science based biomedical model, is individually focussed involving concrete (evidence based) guidance for practical action. The knowledge needed for action is instrumental knowledge – knowledge for a purpose, ‘know how’.
The case against sociology in nursing: (Sharp 1994, 1995):
1) Nursing is rational action directed to achieving measurable outcomes.
2) Nursing needs ‘know how’ not ‘know why’.
3) Nursing needs concrete knowledge based on certainty and unambiguous guidance for action.
4) Nursing is not about complex decision making and is thus non reflexive.
5) Sociology is multi paradigmatic and so cannot offer guidance for action.
6) Sociology is endlessly self reflective and questions all claims and assumptions and thus it is practically useless as it fails to meet the instrumental requirements of the nursing profession.
Another view is that nursing is complex decision making involving critical self reflection based on competing philosophies and theories. Nursing operates in power and social contexts, addressing populations as well as individuals. The knowledge needed is not just for action in practical settings (‘know how’) but for personal and social transformation (‘know why’).
Undergraduate students in practice may not engage much in analytical, critical, self reflective learning. They often describe what they see and read about. They learn task orientated, ‘correctly sequenced psycho-motor movements’ in an instrumental fashion to achieve essential skills and competencies. They often operate in a biomedically dominated frame of reference in chronic and acute illness and disease management with individual patients often in a hospital setting. They also often operate in a context where ‘getting the work done’ is paramount (Melia 1984). This work is often instrumental in nature: giving direct ‘hands on’ patient care. The emphasis is on the ‘doing’ not the ‘knowing’. The cultural view they bring into nursing is dominated by a hospital/medical frame of reference.
This makes sociology ‘difficult.’
Sociology encourages and requires transformational learning which does not sit easily within the current practical and power context of much of nursing practice. However, when students engage with the wider issues, and understand that there are different ways of knowing and examine what it means to develop a sociological imagination (Mills 1959), an opportunity exists for them to develop into ‘knowledgeable doers’ (UKCC 1986) who may transform both themselves, nursing practice and in turn society.
Melia, K. (1984) Student nurses’ construction of occupational socialisation Sociology of Health and Illness6 (2) pp 132-151
Mulholland, J. (1997) The sociology in nursing debate. Journal of Advanced Nursing. 25 p 844-852.
Sharp, K. (1994) Sociology and the nursing curriculum: a note of caution. Journal of Advanced Nursing. 20 pp 391-395
Sharp, K. (1995) Sociology in nurse education: help or hindrance? Nursing Times. 91 (20) pp 34-35
UKCC (1986) Project 2000: A new preparation for practice. UKCC. London
Wright Mills, C. (1959) The Sociological Imagination. Penguin. London 40th ed.